Long QT syndrome patients may faint due to neurocardiogenic syncope
Open accessAbstract
AIMS: Syncope in long QT syndrome (LQTS) is expected to be due to Torsades de Pointes ventricular tachycardia (TdP). Often these patients faint in situations with emotional stress. The aim of the present study was to evaluate whether neurocardiogenic syncope occurs in LQTS. METHODS AND RESULTS: Ten untreated consecutive LQTS patients (age 11-72 years, median 37.5 years, five males and five females from five different families (one KvLQT1 mutation, two HERG mutations in three families and one without established genetic background)) were examined by a head-up tilt-table test (HUT). If syncope did not occur within 25 min, the patient received 0.25 mg nitroglycerine sublingually and the HUT was continued for 20 min. Nine out of 10 patients had a positive HUT. The syncope resulted from a combined vasodepressor and bradycardiac response. There were no cases of TdP. No syncope occurred in a 42-year-old asymptomatic male LQTS patient with a borderline prolonged QTc of 0.45 s and a HERG mutation. In 11 of 21 patients referred for syncope without LQTS a positive HUT was found (P < 0.10). CONCLUSION: Syncope in LQTS can be of neurocardiogenic origin and is not necessarily due to TdP. The reason for neurocardiogenic syncope in LQTS is unknown, but involvement of the autonomic nervous system outside the heart is possible.
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In the pediatric population, significant overlap exists in the clinical presentation of patients with VVS and arrhythmic syncope.
“This is particularly true in the pediatric population, where significant overlap exists in the clinical presentation of patients with VVS and arrhythmic syncope (313,314).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [314]
The Introduction says that fainting in long QT syndrome can occur in circumstances also associated with vasovagal syncope, which can lead to an erroneous vasovagal diagnosis. That supports overlap in presentation for this arrhythmic condition, but the study included patients aged 11–72 and does not establish that significant overlap is particularly characteristic of the pediatric population. (LLM, conf=0.86)
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Olgular Eşliğinde Kardiyoloji II
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- Authors
- Toft, E.
- Affiliations
- Aalborg University (DK)
- Corresponding author
- Toft, E
- ORCID
- Toft, E
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2003-10
- Volume
- 5
- Issue
- 4
- Pages
- 367-370
- ISSN
- 1099-5129 (ISSN-L)
- OpenAlex
- W1989844017
- Cited by
- 25
- References
- 17
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2020: 1 · 2018: 1 · 2017: 4 · 2016: 1 · 2015: 1 · 2014: 3 · 2013: 2
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- long QT syndrome, vasovagal syncope, syncope, torsades de pointes, tilt table test, vasodepressor response, bradycardia, autonomic nervous system, emotional stress
- MeSH terms
- Adult, Female, Humans, Long QT Syndrome, Male, Electrocardiography, Ambulatory, Torsades de Pointes, Tilt-Table Test, Syncope, Vasovagal
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